‘No decision about me, without me,’ said Health Secretary Andrew Lansley, launching his proposed NHS reforms designed to give spending decisions to local GPs. He argues the wishes of patients should be at the heart of every decision made. All of the three main parties, in fact, agree that healthcare should be more personalised, that the experience of patients should take precedence over ‘one size fits all’ provision. Instead, knowledge of individual needs and aspirations should be used to transform services to deliver care appropriate to each unique situation. Patients can now choose hospitals on the basis of indicators such as average wait times, readmission, infection and mortality rates. Increasing information available to patients about the quality of service may seem unobjectionable, but some do question just what it means to ‘empower’ patients. NHS bureaucrats can be accused of using the language of patient choice as cover for increased centralisation and standardisation in the name of a presumed public. Some sceptics fear ‘patient choice’ is a cover for NHS spending cuts – making us take over back office functions like booking our own appointments online – others point to the fundamental contradiction inherent in empowering patients when they ultimately have to comply with treatment regimes set by medical experts.

So what does it mean to be a patient today? With the advent of ‘expert patients’, it seems patients are considered to be as well-versed in the complexities of their conditions as the professionals. In the White Paper they are even referred to as ‘consumers’ and a new organisation, HealthWatch, being set up to represent their interests, is described as an ‘independent consumer champion’. At a local level, they will have to be consulted about GP commissioning decisions to ensure these are shaped by the needs and wants of patients and communities.

Are we seeing the rise of patient empowerment precisely as we see an erosion of traditional medical authority? Does it express radical and principled objection to the old-fashioned paternalism of doctor knows best? Or is it precisely medical expertise that we want when we are sick? Is this not a time when we are most likely to be willing to surrender our choices and devolve responsibility to others? So, just who is it that should be driving priorities in health care delivery: patients, doctors, GP consortia or government policy?

The patient movement works to improve the quality of healthcare. Some of the work entails trying to get standards of care that put patients at institutionalised disadvantage replaced by standards that free (emancipate) patients from that disadvantage.

How equal partnerships between professionals and the public are crucial to improving public services

David Boyle and Michael Harris, NESTA,
December 2009

Behaviour change at population, community and individual levels

Behaviour plays an important role in people’s health (for example, smoking, poor diet, lack of exercise and sexual risk-taking can cause a large number of diseases). Interventions to change behaviour have enormous potential to alter current patterns of disease.